Treatment efficacy of damage control strategy in elderly patients with multiple injuries combined with thoracic trauma / 中华创伤杂志

ABSTRACT

Objective To investigate the efficacy of damage control strategy in treating elderly patients with multiple injuries combined with thoracic trauma and evaluate its efficacy.Methods A retrospective case-control study was performed to analyze the data of 877 elderly patients with multiple injuries combined with thoracic trauma admitted from January 2005 to December 2016.There were 574 males and 303 females,aged 65-94 years (mean,70.8 years).The patients were divided into damage control group (n =406) and non-damage control group (n =471),according to the application of damage control strategy.The injury severity score (ISS) of the damage control group and the non-damage control group were (14.4 ± 8.5) points and (13.7 ± 9.4) points,respectively.The emergency operation rate within 24 hours,the blood loss during emergency operation,the thoracic and abdominal surgery,vascular interventional embolization,thoracic fracture and limb pelvic fracture operation within 72 hours,as well as ICU treatment rate,treatment time,complications,and prognosis were compared between the two groups.Results Fifty-one cases (12.6％) in the damage control group and 93 cases (19.7％) in the non-damage control group underwent emergency operation within 24 hours (P ＜ 0.01).The blood loss during emergency operation were (465.2 ± 329.6) ml in the damage control group and (574.4 ± 437.3) ml in the non-damage control group (P ＜ 0.01).Operation time of the two groups were (108.7 ± 57.1)minutes and(123.5 ± 86.4) minutes,respectively(P ＜ 0.01).In the damage control group and the nondamage control group respectively,there were 25 cases (6.2％) and 48 cases (10.2％) of laparotomy (P ＜ 0.05),23 cases (5.7％) and six cases (1.3％) of vascular interventional embolization (P ＜0.01),41 cases (10.1％) and 29 cases (6.2％) of internal fixation for thoracic fracture (P ＜ 0.05),zero and 232 cases (49.3％) of internal fixation for fracture of limbs and pelvis (P ＜0.01),92 cases (22.7％) and 53 cases (11.3 ％) of external fixation for extremity and pelvic fractures (P ＜ 0.01).A total of 271 cases (66.7％)in the damage control group and 256 cases (54.4％)in the non damage control group were admitted to ICU (P ＜ 0.01),and the ICU treatment time was (8.1 ± 6.5) days and (10.5 ±7.4)days,respectively (P ＜ 0.01).The top three complications for the two groups were atelectasis and pulmonary infection,arrhythmia and heart failure,respiratory failure and acute respiratory distress syndrome (ARDS).In the damage control group and the non-damage control group respectively,the incidence of atelectasis and pulmonary infection were 65％ and 64.5％ (P ＞ 0.05),the incidence of arrhythmia and heart failure were 53.4％ and 60.5％ (P ＜ 0.05),and the incidence of respiratory failure and ARDS were 17.7％ and 23.8％ (P ＜ 0.05).A total of 29 cases died in the damage control group (7.1％) and 53 cases died in the non damage control group (11.3 ％) (P ＜ 0.05).Conclusions Damage control strategy should be applied to treating elderly patients with multiple injuries combined with chest injury.By simplifying or reducing emergency surgery,active ICU treatment,and focusing on the fixation of chest fractures,damage control strategy can effectively reduce complications and improve survival rate.